$2 Million NIH Grant Will Fund Concussion Protocol Study

Published
April 13, 2016

Researchers in the departments of Orthopaedics
and Psychiatry
have been awarded a five-year, $2 million grant to study how the
brain changes following a concussion and how that information may
be used to predict recovery time.

“We know that exercise is good for your brain. When you exercise, you stress your brain the way you stress your heart.”

Seeking to Validate Exercise Intolerance as Biomarker

Leddy and Willer pioneered the use of low-level exercise to help
concussed athletes recover, an approach that directly contradicts
the traditional standard of care mandating prolonged periods of
rest.

The goal of the grant is to validate a concept they developed:
that the inability to exercise above a certain intensity —
exercise intolerance — is a biomarker for concussion.

“We want to demonstrate how exercise intolerance predicts
recovery time. By studying cerebral blood flow through brain
imaging, we will be able to better understand how the brain changes
after a concussion and how it changes back again so patients can
get on with their lives,” Willer says.

Viewing Concussion as Physiologic and Cognitive Injury

Leddy and Willer were among the first researchers to view
concussion as a physiologic, as well as a cognitive, injury.

“We know that exercise is good for your brain,”
Leddy says. “We’ve seen that exercise changes cardiac
output and blood flow in the brain. When you exercise, you stress
your brain the way you stress your heart.”

‘Prolonged Rest Can Create Anxiety and Depression’

While rest is critical just after a concussion, the researchers
note that prolonged rest can be detrimental to recovery.

“Prolonged rest can create anxiety and depression in
athletes,” says Willer. “They end up focusing on their
illness.”

In recent years, a more proactive approach has been seen as
potentially more beneficial, a point noted by the NIH reviewers,
one of whom commented, “Who better to lead in this new
approach than the people in Buffalo who have been saying this all
along?”

Adolescence Time of Dramatic Change in Brain

About 90 teenagers who play sports will participate in a
clinical study. Willer says the research on concussions will focus
on teenagers because “they are the most vulnerable and they
take the longest time to recover.”

“Adolescence is a time of dramatic change in the
brain,” according to Leddy. During adolescence, he says, the
brain is undergoing major hormonal changes, changes in blood flow
and the maturation of the autonomic nervous system, which governs
involuntary processes like breathing.

“By evaluating how much exercise a patient can do before
they start having symptoms, our approach immediately confirms that
a patient has had a concussion, but more importantly, it tells us
how serious the concussion is and about how long it will be before
we see full recovery,” Leddy says.

Not All Concussion Recovery is on Same Timetable

While most teens who suffer concussions recover pretty quickly,
about 15 percent will exhibit symptoms for much longer, a condition
known as post-concussion syndrome. For these individuals, recovery
will take months, not weeks.

A case in point is Sean Kaiser, a senior at Frontier High
School. Just days before going back to school his junior year, he
sustained a concussion during football practice.

Almost as soon as Sean started walking on the treadmill, his
physical symptoms, such as headache and dizziness, returned, a sign
that he was also likely to be cognitively impaired.

“If a patient has exercise intolerance as Sean did, that
typically indicates cognitive intolerance as well,” says
Willer. “The person is as smart as he or she always was, but
has very little stamina. For a high-achieving high school student
like Sean, it can be devastating.”

Still Much to be Learned About Effects on Body, Brain

Once Willer and Leddy knew that Sean’s recovery would take
months, not weeks, they scheduled a meeting so they could properly
inform his parents, his guidance counselor, the school nurse and
all his teachers about how best to deal with Sean’s
injury.

Willer recalls: “We told them, ‘There will be points
in the day where he is going to hit a wall. At that point, he is
taking in nothing. He needs to leave the room and go to a quiet
place where there is no stimulation.’”

The teachers made numerous accommodations and Sean completed his
junior year successfully. Knowing ahead of time that his recovery
was going to take a long time was key, says Leddy, but adds there
is still much more to be learned about how concussions affect both
body and brain.